International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2005
Randomized Controlled Trial Comparative StudyAutomated regular boluses for epidural analgesia: a comparison with continuous infusion.
Intermittent epidural bolus dosing is a method of drug delivery that can prolong the duration of labour analgesia induced by a combined spinal epidural (CSE). In this randomized, double-blinded study, we compared the analgesic efficacy of two drug delivery systems: regular intermittent epidural boluses and continuous epidural infusion and assessed the incidence of breakthrough pain after CSE. ⋯ Automated regular bolus delivery of epidural analgesia when compared with continuous infusion decreased the incidence of breakthrough pain and increased maternal satisfaction. In a busy obstetric unit, this may also serve to decrease the anesthetists' workload.
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Int J Obstet Anesth · Oct 2005
Case ReportsLow-dose sequential combined spinal-epidural: an anaesthetic technique for caesarean section in patients with significant cardiac disease.
In the United Kingdom, cardiac disease is the second most common cause of all maternal deaths. The best anaesthetic technique for caesarean section in these patients has yet to be established. ⋯ Invasive monitoring was used in each case, and drugs with significant cardiovascular effects were avoided or used with extreme caution. Multidisciplinary team involvement, including serial echocardiography in the antenatal period, is strongly recommended.
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Intrathecal morphine can produce hypothermia in animals. This side effect has been reported in humans, but has not been thoroughly studied in obstetrics. ⋯ We conclude that symptomatic hypothermia is an occasional side effect of cesarean section under spinal anesthesia. We believe this syndrome is due to intrathecal morphine. While the duration is limited to 6h, lorazepam appears to treat both hypothermia and symptoms.
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Int J Obstet Anesth · Oct 2005
Randomized Controlled Trial Comparative StudyIs ephedrine infusion more effective at preventing hypotension than traditional prehydration during spinal anaesthesia for caesarean section in African parturients?
Hypotension following spinal anaesthesia for caesarean section may result in maternal nausea and vomiting and decreased uteroplacental blood flow with possible fetal acidaemia. Numerous methods have been tried to minimise hypotension. In developing countries where resources are limited, this study aimed to compare a standard infusion of ephedrine with traditional prehydration to prevent spinal hypotension. ⋯ Prophylactic ephedrine given by standard infusion set was more effective than crystalloid prehydration in the prevention of hypotension during spinal anaesthesia for elective caesarean section.
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Int J Obstet Anesth · Oct 2005
Case ReportsEpidural catheter-induced paresthesia accompanied by changes in skin color and temperature in an obstetric patient.
Placement of epidural catheters for labor analgesia is a common procedure that has become more popular in recent years. However, this procedure can often cause paresthesia, which is typically characterized as a transient and intense burning pain radiating to the hip or leg. In this case report, we describe a patient who had persistent paresthesia in her right foot caused by an indwelling epidural catheter, which was successfully relieved following a partial withdrawal of the epidural catheter. ⋯ This cold and pale skin on the right foot represents a localized sympathetic discharge associated with the epidural-induced paresthesia, a phenomenon that has not previously been described. Based on the location of the paresthesia and the pathway of the sympathetic nerve fibers, it is unlikely that this localized sympathetic discharge was due to a direct irritation of the preganglionic sympathetic fibers in the spinal nerve roots by the epidural catheter and thus, a spinal reflex was probably involved. This phenomenon provided us with additional clinical evidence of nerve root irritation, which prompted us to act quickly, and resulted in a favorable outcome.